Both young and old people showed better brain health with optimal cardiovascular scores

Action Points

Cardiovascular health at young and old ages were associated with better brain function, according to two reports: the first, a longitudinal study of older adults in France; the second, an observational assessment of young adults in England.

Note that prior analyses have examined links between cognitive outcomes and cardiovascular risk factors mostly in middle age, not earlier or later in life, and earlier investigations also focused more often on the deleterious associations of cardiovascular risk factors with cognitive outcomes rather than the advantageous associations of optimal risk factor status.

Cardiovascular health at young and old ages showed ties to better brain function, according to two reports.

Previous analyses have examined links between cognitive outcomes and cardiovascular risk factors mostly in middle age, not earlier or later in the life span, noted Jeffrey L. Saver, MD, of the University of California Los Angeles, and Mary Cushman, MD, MSc, of the University of Vermont in Burlington.

Earlier investigations also "more often focused on the deleterious associations of moderate or severe cardiovascular risk factors with cognitive outcomes rather than the advantageous associations of attaining optimal status for each cardiovascular health factor; i.e., ideal cardiovascular health," they wrote in an editorial accompanying the two studies in JAMA.

Older Adults

Among older adults in France, additional improvements in cardiovascular health score were associated with lower risks for dementia and lower rates of cognitive decline, reported Cecilia Samieri, PhD, of the Université de Bordeaux, and co-authors.

"Each additional favorable health factor or behavior was associated with a 10% lower risk to develop dementia in the following decade," Samieri told MedPage Today.

In the Three-City Study, 6,626 people ages 65 or older from Bordeaux, Dijon, and Montpellier who did not have a history of cardiovascular diseases or dementia at baseline underwent in-person neuropsychological testing from 1999 to 2016 and systematic detection of incident dementia until July 2016.

The researchers assessed participants' adherence to the AHA Life's Simple 7 metrics at baseline. Each item was scored as 0 (poor), 1 (intermediate), or 2 (optimal):

Nonsmoker for more than 12 months

Body mass index <25

Regular physical activity

Eating fish twice a week or more, and fruits and vegetables daily

Untreated total cholesterol <200 mg/dL

Untreated fasting glucose <100 mg/dL

Untreated blood pressure <120/80 mm Hg

Participants had a mean age of 74 at baseline and 63% were women. At baseline, 36.5% of participants had 0 to 2 metrics at optimal levels, and 6.5% had 5 to 7 optimal metrics.

For participants with 0 to 2 optimal metrics, the incidence rate of dementia per 100 person-years over an average follow-up period of 8.5 years was 1.56. For individuals with 3 to 4 optimal metrics, it was 1.23; for those with 5 to 7 optimal metrics, it was 0.83.

In multivariable models, the risk of dementia decreased linearly with both increasing number of metrics at the recommended optimal level (HR 0.90 per each additional metric) and increasing global cardiovascular health score (HR 0.92 per 1-point increase).

The researchers used composite scores of global cognition and memory to determine cognitive decline. In standard units, with values indicating distance from population means (0 equal to the mean, and +1 equal to 1 SD above the mean), the estimated change in cognitive score for each additional metric at the optimal level was 0.031 standard units at inclusion, 0.068 at year 6, and 0.072 at year 12.

Young Adults

Optimal cardiovascular health in 125 young adults in England was associated with more robust cerebral perfusion and fewer subclinical lesions in brain white matter, reported Paul Leeson, PhD, of the University of Oxford, and colleagues.

Examining eight modifiable cardiovascular risk factors, the researchers assigned a value of 1 for each item at the recommended level:

Both this study and the Three-City Study of older adults in France were observational, so they indicate association, not causation, Saver and Cushman noted. And in both studies, unmeasured and residual confounding may exist.

But with these caveats, these studies convey an immediate message to clinicians, policymakers, and patients, they said: "Available evidence indicates that to achieve a lifetime of robust brain health free of dementia, it is never too early or too late to strive for attainment of ideal cardiovascular health."

"From a pragmatic and public health perspective, promoting change in cardiovascular health from poor to intermediate levels may be more achievable and have a greater population-level effect than the more challenging change from poor to optimal levels," she said.

"These results offer new insights on the way to formulate recommendations for dementia prevention which may be implemented at both collective and individual levels."

The Three-City Study was conducted under a partnership agreement between INSERM, the ISPED of the University of Bordeaux, and Sanofi-Aventis. One researcher reported receipt of a grant from Roche. No other disclosures were reported.

The Oxford study was funded by a British Heart Foundation (BHF) project grant, the Oxford BHF Centre for Research Excellence, and National Institute for Health Research, Oxford Biomedical Research Centre. Researchers reported relationships with Siemens Healthcare, Michael J. Fox Foundation, Deutsche Parkinson Gesellschaft, and Prothena Biosciences.

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.